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General NPI Number Information
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NPI Number | 1619430006
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Entity Type | Individual
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Provider Name | TARA A O'BYRNE BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 412 E MADISON ST STE 1206
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City | TAMPA
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State | FL
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Zip | 33602-4619
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Country | US
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Telephone | 877-535-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 4620 N STATE ROAD 7 STE 300
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5867
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Country | US
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Telephone | 877-535-7888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-21-12155
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-59838
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License Number State | FL
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